September 24, 2017

Georgia politicians react to impose restrictions – Part III

What happens when the beliefs of one group of people affect the freedom and rights of another group of people?

A month ago, I wrote Part 1 and Part 2 of this series on Georgia Senate Bill 169, a proposed legislation which slams into conflict two groups of people. The supporters of this bill view that laboratory embryos should be afforded the same rights and protections as a live-born child. The other group opposes the bill and believes that infertile couples who are trying to have a baby should not have their options overly restricted. So just what is this bill all about?

There are multiple components to this bill. The first part reads:

(a) It shall be unlawful for any person or entity to intentionally or knowingly create or attempt to create an in vitro human embryo by any means other than fertilization of a human egg by a human sperm.
(b) The creation of an in vitro human embryo shall be solely for the purpose of initiating a human pregnancy by means of transfer to the uterus of a human female for the treatment of human infertility. No person or entity shall intentionally or knowingly transfer or attempt to transfer an embryo into a human uterus that is not the product of fertilization of a human egg by a human sperm.

In our program, there’s only one way we know how to create embryos, namely by fertilizing human eggs with human sperm. I don’t know of any other programs that are doing it any differently, such as any using kangaroo eggs or hamster sperm, but if there are, I guess they’d be in trouble if this bill passes. Granted, this clause could also be interpreted to ban cloning. However, that would be redundant as there are already federal provisions in place aimed at banning cloning. This part of the bill doesn’t affect my patients, as we presently don’t do cloning.

The next section addresses financial compensation given for embryos or gametes. It reads:

No person or entity shall give or receive valuable consideration, offer to give or receive valuable consideration, or advertise for the giving or receiving of valuable consideration for the provision of gametes or in vitro human embryos. This Code section shall not apply to regulate or prohibit the procurement of gametes for the treatment of infertility being experienced by the patient from whom the gametes are being derived.

In a free society, people enter into agreements based on mutual benefit. Infertile couples sometimes need help from other people in the form of donor sperm or donor eggs in order to fulfill their dreams of parenthood. As a way of thanking the donors, financial compensation is routinely offered. To do away with this option would be disastrous if we look to the UK as an example. Over there, paying for donors is forbidden. This all but eliminates anyone from wanting to participate, leading to a loss of options for most couples, unless they are willing to resort to drastic risky behavior. For some of them, there is the option of coming to the US. In the past two years, I’ve had the chance to help four couples from countries in which paid egg donation is banned. After they got pregnant, they vented their anger at the unfair restrictions in their home countries which compelled them to come to the US. Well, if this happens in the US, I’m not sure where patients would go for their treatment, maybe Mexico?

The next section reads:

The in vitro human embryo shall be given an identification by the facility for use within the medical facility. Records shall be maintained that identify the donors associated with the in vitro human embryo, and the confidentiality of such records shall be maintained as required by law.

This is just plain meddlesome and seeks to slap a regulation onto something that is already routinely done out of common sense. We already document and label meticulously, so again, this would not affect us much.

Going on, the next paragraph reads:

19-7-64. (a) A living in vitro human embryo is a biological human being who is not the property of any person or entity. The fertility physician and the medical facility that employs the physician owe a high duty of care to the living in vitro human embryo. Any contractual provision identifying the living in vitro embryo as the property of any party shall be null and void. The in vitro human embryo shall not be intentionally destroyed for any purpose by any person or entity or through the actions of such person or entity. (b) An in vitro human embryo that fails to show any sign of life over a 36 hour period outside a state of cryopreservation shall be considered no longer living.

Here’s where it starts to get a little annoying. This vague statement suggests that the writers of this bill are not familiar with what actually happens in an embryology lab. When we put the sperm and egg together from a husband and wife couple, we have to assign somebody the power to determine what is done with that embryo — whether it is transferred back into the wife, transferred into someone else or frozen for the future. Whether or not it is labeled as the “property” of anyone, we have to give someone the legal authority to make the call of what happens to the embryo. This is like passing a law stating that a child can not be labeled as the property of his parents. That’s fine and dandy, but then is it OK for someone to grab a baby out of a stroller at the mall and take the baby home because it wasn’t the “property” of the parents? Very silly. Whether or not you label it a property, there HAS to be some legal designation, enforced by contract, to confer rights to certain people regarding the embryos, because you know what? The embryos can’t make decisions on their own.

The next clause appears redundant because it states:

Only medical facilities meeting the standards of the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists shall cause the fertilization of an in vitro human embryo. A person who engages in the creation of in vitro human embryos shall be qualified as a medical doctor licensed to practice medicine in this state and shall possess specialized training and skill in artificial reproductive technology in conformity with the standards established by the American Society for Reproductive Medicine or the American College of Obstetricians and Gynecologists.

IVF is a medical procedure and as such, can only be done by medical doctors. There is no real need to restate it. Again, this is verbose, but not really changing anything that we already do.

The next section is where it starts to get really intrusive:

In the interest of reducing the risk of complications for both the mother and the transferred in vitro human embryos, including the risk of preterm birth associated with higher-order multiple gestations, a person or entity performing in vitro fertilization shall limit the number of in vitro human embryos created in a single cycle to the number to be transferred in that cycle in accord with Code Section 19-7-67.

In order to grasp the impact of this intrusion, let’s review how IVF works. When a couple make the decision to do IVF,  our goal is to help the couple create some healthy embryos that will grow into healthy babies. We help do this by putting their eggs and sperm together. The procedure take a lot of dedicated work from a team of many people. The main labor is the surgery involved in extracting the eggs. The good thing is that each additional sperm or each additional egg does not add all that much cost to the process.  Therefore, it would be highly wasteful to do IVF with just one egg and one sperm. We can’t know for sure how many of the eggs we get will successfully fertilize. Out of those that do, we can’t know for sure which will continue to survive until the day of transfer. Can you imagine a lawmaker telling you that you can’t put more gasoline in our car than you’re going to use each day?

On the day of an IVF egg retrieval, we surgically remove all the eggs that stimulated for that month. We try our best to fertilize every one of them, because we know that most of them will not end up capable of becoming a healthy baby. By attempting to fertilize all of them, we get the best chance that at least one or some of them will end up being good. In a good scenario, we get enough healthy embryos to transfer as well as some additional ones to freeze for future attempts. For many couples who fail IVF in the first fresh attempt, those frozen embryos are the difference between their ending up with a baby in their home vs. remaining sadly childless.

The rest of the bill piles on further restrictions by telling us how many embryos we can transfer. This issue of embryo number is such a loaded issue that I’m going to save it for the next post.

  • Robin

    Thank you Dr. Lee for a full physician’s take on this bill and why it just doesn’t cut the mustard.

    As a layman I first lament one thing, in prohibiting any thing other than human eggs and a human sperm to be used in fertility treatments, this bill would prevent the purposeful breeding of mermaids, centaurs and any other such mythical creatures which then could have gone on to star in fantasy movies without the use of trick photography.

    (hint hint, methinks as you pointed out that the bill writers weren’t grounded in the reality of having a CLUE about fertility treatment procedures)

  • http://www.cynicsunlimited.com Emilia Liz

    I live in Canada, and here payments for any type of donation (egg, sperm, bone marrow) is forbidden. As a result we have scores of people waiting for such donations, including a friend of mine with leukemia. As much as I love the romantic idea that humans are naturally altruistic and go through tremendous efforts to help their fellow man without compensation, the world unfortunately doesn’t work that way.